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The estate of a woman who was denied long-term disability benefits after she underwent a hysterectomy may be entitled to those benefits, a federal appeals court ruled Thursday.
Christine Cannon, formerly an employee with PNC Financial Services Group Inc., filed a claim with the firm in December 2012 for long-term disability benefits after experiencing “abdominal and pelvic pain” after undergoing a hysterectomy a few months before, according to the opinion by the U.S. Court of Appeals for the Sixth Circuit in Cincinnati.
Ms. Cannon said she could not work because sitting was painful, according to the opinion.
Ms. Cannon's claim was initially approved by Liberty Life Assurance Co. of Boston, the plan administrator, but her benefits were discontinued in mid-April 2013 “on the basis that she no longer met the plan's definition of disability,” according to the appeals court's opinion.
To qualify for long-term disability benefits under PNC's plan, the employee must be “unable to perform the material or essential duties of your own occupation as it is normally performed in the national economy,” according to the opinion.
Ms. Cannon sued to recover long-term disability benefits under the Employee Retirement Income Security Act of 1974.
In a letter, Ms. Cannon's doctor explained that “She was diagnosed with pudendal neuralgia as well as pelvic floor muscle dysfunction and these conditions are associated with pain with sitting, and it is not possible for the patient to perform a job that requires that she sit.”
Despite the letter, the U.S. District Court for the Western District of Kentucky ruled in favor of the PNC Financial Services.
Finding that the decision of the lower court was “flawed,” the appeals court vacated the ruling and remanded the case to Liberty “for a full and fair inquiry into her claim for LTD benefits.”
“Liberty's decision to deny benefits was arbitrary and capricious for two reasons. First, Cannon asserted that she could not perform her job because her pelvic pain made her unable to sit. Liberty failed to consider that Cannon's two diagnoses — pudendal neuralgia and pelvic floor muscle dysfunction — are associated with pain while sitting … To fail to address them is an arbitrary and capricious denial of benefits,” the court wrote.
Secondly, the court continued, Ms. Cannon's doctor's “letter provided an explanation for Cannon's need for disability based on existing medical evidence—namely, Cannon's two diagnoses as a result of the recent surgery that he performed on her and that she was still recovering from—and should have been addressed by Liberty.”
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